Friday, March 31, 2017

Gale Ridge could tell something was wrong as soon as the man walked into her office at the Connecticut Agricultural Experiment Station. He was smartly dressed in a collared shirt and slacks, but his skin didn't look right: It was bright pink, almost purple — and weirdly glassy.

Without making eye contact, he sat hunched in the chair across from Ridge and began to speak. He was an internationally renowned physician and researcher. He had taught 20 years' worth of students, treating patients all the while, and had solved mysteries about the body's chemistry and how it could be broken by disease. But now, he was having health issues he didn't know how to deal with.

"He was being eaten alive by insects," Ridge, an entomologist, recalled recently. "He described these flying entities that were coming at him at night and burrowing into his skin."

Their progeny, too, he said, seemed to be inside his flesh. He'd already seen his family doctor and dermatologist. He'd hired an exterminator to no avail. He had tried Epsom salts, vinegar, medication. So he took matters into his own hands, filling his bathtub with insecticide and clambering in for some relief.

But even that wasn't working. The biting, he said, would begin again. Ridge tried her best to help. "What I did was talk to him, explaining the different biologies of known arthropods that can live on people … trying to get him to understand that what he is seeing is not biologically known to science," she said.

She saw him only four or five times. Three weeks after he first walked into her office, she heard that he was dead. Heart attack, the obituaries declared. No mention of invisible bugs, psychological torment, self-mutilation. But the entomologist was convinced that wasn't the whole story.

Thursday, March 30, 2017

In the early nineteen-sixties, when cholesterol was declared an enemy of health, my parents quickly enlisted in the war on fat. Onion rolls slathered with butter, herring in thick cream sauce, brisket of beef with a side of stuffed derma, and other staples of our family cuisine disappeared from our table. Margarine dethroned butter, vinegar replaced cream sauce, poached fish substituted for brisket. I recall experiencing something like withdrawal, daydreaming about past feasts as my stomach grumbled. My father's blood-cholesterol level—not to mention that of his siblings and friends—became a regular topic of conversation at the dinner table. Yet, despite the restrictive diet, his number scarcely budged, and a few years later, in his mid-fifties, he had a heart attack and died.

The dangers of fat haunted me after his death. When, in my forties, my cholesterol level rose to 242—200 is considered the upper limit of what's healthy—I embarked on a regimen that restricted fatty foods (and also cut down on carbohydrates). Six months later, having shed ten pounds, I rechecked my level. It was unchanged; genes have a way of signalling their power. But as soon as my doctor put me on just a tiny dose of a statin medication my cholesterol plummeted more than eighty points.

The catastrophe struck Wanda Wickizer on Christmas Day 2013. A generally healthy, energetic 51-year-old, she suddenly found herself vomiting all day, racked with debilitating headaches. When her alarmed teenage son called an ambulance, the paramedics thought that she had food poisoning and didn't take her to the emergency room. Later, when she became confused and groggy at 3 a.m., her boyfriend raced her to Sentara Norfolk General Hospital in coastal Virginia, where a scan showed she was suffering from a subarachnoid hemorrhage. A vessel had burst, and blood was leaking into the narrow space between the skull and the brain.

During a subarachnoid hemorrhage, if the pressure in the head isn't relieved, blood accumulates in that narrow space and can push the brain down toward the neck. Vital nerves that control breathing and vision are compressed. Death is imminent. Wickizer was whisked by helicopter ambulance to the University of Virginia Medical Center in Charlottesville, 160 miles away, for an emergency procedure to halt the bleeding.

After spending days in a semi-comatose state, Wickizer slowly recovered and left the hospital three weeks after the hemorrhage, grateful to be alive. But soon after she returned home to her two teenage children, she found herself confronted with a different kind of catastrophe. Wickizer had had health insurance for most of her adult life: Her husband, who died in 2006, worked for the city of Norfolk, which insured their family while he was alive and for three years beyond. After his death, Wickizer worked in a series of low-wage jobs, but none provided health insurance. A minor pre-existing condition — she was taking Lexapro, a common medicine for depression — meant that her only insurance option was to be funneled into the "high-risk pool" (a type of costly insurance option that was essentially rendered obsolete by the Affordable Care Act and now figures in some of the G.O.P. plans to replace it). She would need to pay more than $800 per month for a policy with a $5,000 deductible, and her medical procedures would then be reimbursed at 80 percent. She felt she couldn't afford that. In 2011, she decided to temporarily stop working to tend to her children, which qualified them for Medicaid; with trepidation, she left herself uninsured.

And so in early 2014, without an insurer or employer or government agency to run interference between her and the hospital, she began receiving bills: $16,000 from Sentara Norfolk (not including the scan or the E.R. doctor), $50,000 for the air ambulance. By the end of January, there was also one for $24,000 from the University of Virginia Physicians' Group: charges for some of the doctors at the medical center. "I thought, O.K., that's not so bad," Wickizer recalls. A month later, a bill for $54,000 arrived from the same physicians' group, which included further charges and late fees. Then a separate bill came just for the hospital's charges, containing a demand for $356,884.42 but little in the way of comprehensible explanation.

Wednesday, March 29, 2017

SpaceX and Tesla CEO Elon Musk is backing a brain-computer interface venture called Neuralink, according to The Wall Street Journal. The company, which is still in the earliest stages of existence and has no public presence whatsoever, is centered on creating devices that can be implanted in the human brain, with the eventual purpose of helping human beings merge with software and keep pace with advancements in artificial intelligence. These enhancements could improve memory or allow for more direct interfacing with computing devices.

Musk has hinted at the existence of Neuralink a few times over the last six months or so. More recently, Musk told a crowd in Dubai, "Over time I think we will probably see a closer merger of biological intelligence and digital intelligence." He added that "it's mostly about the bandwidth, the speed of the connection between your brain and the digital version of yourself, particularly output." On Twitter, Musk has responded to inquiring fans about his progress on a so-called "neural lace," which is sci-fi shorthand for a brain-computer interface humans could use to improve themselves.

Tuesday, March 28, 2017

On a velvety March evening in Mandeville Canyon, high above the rest of Los Angeles, Norman Lear's living room was jammed with powerful people eager to learn the secrets of longevity. When the symposium's first speaker asked how many people there wanted to live to two hundred, if they could remain healthy, almost every hand went up. Understandably, then, the Moroccan phyllo chicken puffs weren't going fast. The venture capitalists were keeping slim to maintain their imposing vitality, the scientists were keeping slim because they'd read—and in some cases done—the research on caloric restriction, and the Hollywood stars were keeping slim because of course.

When Liz Blackburn, who won a Nobel Prize for her work in genetics, took questions, Goldie Hawn, regal on a comfy sofa, purred, "I have a question about the mitochondria. I've been told about a molecule called glutathione that helps the health of the cell?" Glutathione is a powerful antioxidant that protects cells and their mitochondria, which provide energy; some in Hollywood call it "the God molecule." But taken in excess it can muffle a number of bodily repair mechanisms, leading to liver and kidney problems or even the rapid and potentially fatal sloughing of your skin. Blackburn gently suggested that a varied, healthy diet was best, and that no single molecule was the answer to the puzzle of aging.

Yet the premise of the evening was that answers, and maybe even an encompassing solution, were just around the corner. The party was the kickoff event for the National Academy of Medicine's Grand Challenge in Healthy Longevity, which will award at least twenty-five million dollars for breakthroughs in the field. Victor Dzau, the academy's president, stood to acknowledge several of the scientists in the room. He praised their work with enzymes that help regulate aging; with teasing out genes that control life span in various dog breeds; and with a technique by which an old mouse is surgically connected to a young mouse, shares its blood, and within weeks becomes younger.

Sunday, March 26, 2017

What if the surgeon started slicing into my knee before it was completely numb?

That was my biggest fear, while weighing whether to remain alert and watch the operation on the cartilage in my right knee, or to be put to sleep, preserving my peaceful ignorance.

Rational or otherwise, my reasons for staying awake — an option increasingly taken by patients, the subject of the accompanying article — prevailed.

1) I don't like general anesthesia's side effects.

2) For a long year, my knee pain had resisted straightforward diagnosis and treatment. I wanted an ah-ha! glimpse of the problem.

3) Ever since I was a child, I have watched when the doctor gives me an injection. Not because I am brave, masochistic or even curious. On the contrary. Looking away, I imagine something far scarier. So watching a medical procedure has always been a form of self-soothing.

Jay Parkinson's star was rising in 2009. Hailed in the media as the "doctor of the future," Parkinson had created a transformational Facebook-style application for doctor-patient conversations called Hello Health. Then he was brought in by a fast-growing startup called Tumblr to devise a strategy for their employees' health care needs. That conversation, in which Parkinson advocated for a shift to digital methods (like SMS) of communicating with clinicians, inspired him to start his own company, Sherpaa.

Through Sherpaa, employees at companies like Tumblr were given an email address and phone number, which they could use to reach a doctor at any time. After a segment aired on national television in 2012 about the company's simple but effective approach, Parkinson says Sherpaa was able to hire its first seasoned corporate executive. Less than six months later, Parkinson brought on another New York-based senior executive with human resources experience, and raised $1.85 million. Everything was going well.

Less than five years later, Sherpaa's investors had all but given up on the company—and Parkinson was locked in a protracted battle to save it. What happened?

Dr. Asif Ilyas, a hand and wrist surgeon, was about to close his patient's wound. But first he offered her the opportunity to behold the source of her radiating pain: a band of tendons that looked like pale pink ribbon candy. With a slender surgical instrument, he pushed outward to demonstrate their newly liberated flexibility.

"That's pretty neat," the patient, Esther Voynow, managed to gasp.

The operation Dr. Ilyas performed, called a De Quervain's release, is usually done with the patient under anesthesia. But Ms. Voynow, her medical inquisitiveness piqued and her distaste for anesthesia pronounced, had chosen to remain awake throughout, her forearm rendered numb with only an injection of a local anesthetic.

TEETH
The Story of Beauty, Inequality, and the Struggle for Oral Health in America
By Mary Otto
291 pp. The New Press. $26.95.

Politicians, journalists and researchers have a long-running problem when it comes to talking about class. The definitions we use are myriad and not always overlapping. Is the boundary of the middle class a college degree, a certain level of income? Perhaps a certain type of job: a teacher or a doctor versus a coal miner or factory worker? We might be missing a still more useful — and more personal — indicator, however.

This is the premise, though not so bluntly stated, of Mary Otto's new book, "Teeth: The Story of Beauty, Inequality, and the Struggle for Oral Health in America." The dividing line between the classes might be starkest between those who spend thousands of dollars on a gleaming smile and those who suffer and even die from preventable tooth decay.

If the idea of death from tooth decay is shocking, it might be because we so rarely talk about the condition of our teeth as a serious health issue. Instead, we think of our teeth as the ultimate personal responsibility. We fear the dentist because we fear judgment as well as pain; we are used to the implication that if we have a tooth problem, if our teeth are decaying or crooked or yellow, it is because we have failed, and failed at something so intimate that it means we ourselves are failures.

Hardly a day goes by that people don't tell me that one or more dietary supplement has cured or prevented an ailment of theirs or suggest that I try one to treat a problem of my own. And I am not immune to wishful thinking that an over-the-counter vitamin, mineral or herb may help to keep me healthy or relieve some distress without having to see a doctor.

I have succumbed to several popular suggestions, including melatonin and magnesium to improve my sleep, glucosamine-chondroitin to counter arthritic pain and fish oil to protect my brain and heart. I take these even knowing that irrefutable, scientifically established evidence for such benefits is lacking and I may be paying mightily for a placebo effect.

But as a scientifically trained journalist, I feel obliged to help others make rational decisions about which, if any, dietary supplements may be worth their hard-earned dollars. I'll start with the bottom line on the most popular of these, the daily multivitamin/mineral combo: If you are a healthy adult with no known nutritional deficiencies, save your money.

An independent panel convened by the National Institutes of Health concluded that evidence is lacking for or against the ability of a multivitamin to prevent chronic disease. The American Cancer Society, the American Heart Association and the United States Preventive Services Task Force, among others, have found no role for a one-a-day supplement to prevent cancer or heart disease; they recommend instead a balanced dietwith a variety of foods as likely to be more effective than any capsule.

This may sound like an obvious statement, but it's an important one: Doctors aren't computers. You can't input a set of symptoms into a doctor and have him or her output a bulletproof diagnosis and treatment. Doctors, like everyone else, are influenced by the world around them, by a bevy of social and cultural and professional cues that affect their work and productivity. This, of course, has important ramifications for the ways in which medicine is structured and practiced.

One fascinating concept within the study of how doctors conceptualize their work is the concept of "disease prestige." As the name suggests, the basic idea is that there's a general hierarchy in which some diseases are seen as more, well, prestigious than others. One Norwegian sociologist, Dag Album, has for a long time been surveying how doctors in Norway rate different diseases in terms of prestige, and in a new paper in Social Science & Medicine, he and two other researchers show that over the decades, there's been a fairly stable — and rather telling — hierarchy.

The authors used data from three studies of Norwegian physicians, conducted in 1990, 2002, and 2014, in which the physicians were asked to rate 38 categories of diseases on a prestige scale from 1 to 9, based on how they felt health professionals viewed the disease-category in question. In all three surveys, there was stability at the top: Leukemia, brain tumors, and myocardial infarctions (heart attacks) were the top three in all three surveys, though the order switched around. At the bottom were fibromyalgia, depression, anxiety, and cirrhosis of the liver.

One afternoon in November, Fran Serenade led me and her daughter Barbie down a steep section of the Appalachian trail. The sun was high and Fran hiked briskly, ducking the blue-green diagonals of fir trees, her hair wild behind her. She wanted to show me her log cabin, which was off the trail next to a red barn by a blue lake with a pretty waterfall. Outside the barn, we met Fran's kitty, Amici, and a handful of other cats, all of them wearing knit caps. Fran pet Amici, who followed her, mewling.

Inside the cabin, a fire raged in the fireplace. Fran pointed out her favorite things: an antique icebox; an embroidered tablecloth; a crochet basket. Then we were off to Tai Chi practice.

With her mountain of blonde curls, heart-shaped face, hip-hugging jeans, and tiny waist, Fran recalls a young Dolly Parton. She's so pretty, she's almost doll-like. Barbie is slim and pretty, too, though, in her leopard print vest and red lipstick, her look is less country, more glam. Mother and daughter both wore heels, even as we hiked.

It turns out heels work perfectly well on virtual trails, no matter how steep. The trail and cabin we visited exist inside an online virtual world called Second Life. They were designed to recall a real-world trail and cabin in the Blue Ridge Mountains of North Carolina, where Fran once lived. Fran Serenade is the avatar of Fran Swenson, an 89-year-old former nurse with a head of silver curls and a Brooklyn accent. Barbie is the avatar of Barbara, her daughter in real life.